Tidal volume and airway pressure under percutaneous transtracheal ventilation without a jet ventilator: comparison of high-flow oxygen ventilation and manual ventilation in complete and incomplete upper airway obstruction models.
Tidal volume and airway pressure under percutaneous transtracheal ventilation without a jet ventilator: comparison of high-flow oxygen ventilation and manual ventilation in complete and incomplete upper airway obstruction models.
复制标题
不使用喷射呼吸机的经皮经气管通气下的潮气量和气道压力：完全和不完全上气道阻塞模型中高流量氧气通气和手动通气的比较。
DOI：
10.1007/s00540-013-1733-2
复制
发表时间：
2013
影响因子：
2.8
通讯作者：
Sobue K
中科院分区：
文献类型：
--
作者：
Sasano N;Tanaka A;Muramatsu A;Fujita Y;Ito S;Sasano H;Sobue K
目的经皮经气管插管呼吸机(PTV)可在不能呼吸、不能插管的情况下抢救生命。本研究的目的是通过测量潮气量(Vts)和气道压力(Paw)来评价PTV在高流量氧气通气和人工通气中的效果。方法分别检测14G、16G、18G和20G静脉导管和微小气管切开导管。在高流量氧气通气组，流量设定为10 L/分钟，吸气相：呼气相(I：E)为1 S：4 S(完全性上呼吸道阻塞模型)，1 S：1 S(不完全性阻塞模型)。人工通气时，完全性梗阻模型中I：E为2 S：4；不完全梗阻模型中I：E为2 S：3 S。结果在高流量通气法中，14G导管完全阻塞和不完全阻塞时，平均VT分别约为150和100微升。随着孔径的减小，得到的VT值减小。在14G导管完全阻塞和不完全性上呼吸道阻塞的情况下，手动通气组的平均VT分别大于300毫升和约260毫升。在高流量的情况下，气道压力趋于较高。气管切开微创导管产生的VT超过800mlVT，呼气末正压几乎为零。结论大流量机械通气虽然VT较小，但仍可导致较高的气道压力，这可能与大流量引起的窥视效应有关。
PurposePercutaneous transtracheal ventilation (PTV) can be life-saving in a cannot ventilate, cannot intubate situation. The aim of this study was to investigate the efficacy of PTV by measuring tidal volumes (VTs) and airway pressure (Paw) in high-flow oxygen ventilation and manual ventilation using a model lung.MethodsWe examined 14G, 16G, 18G, and 20G intravenous catheters and minitracheotomy catheters. In high-flow oxygen ventilation, the flow was set to 10 L/min, while the inspiratory:expiratory phases (I:E) were 1 s:4 s in the complete upper airway obstruction model and 1 s:1 s in the incomplete obstruction model. In manual ventilation, I:E were 2 s:4 s in the complete obstruction model and 2 s:3 s in the incomplete obstruction model. We ventilated through each catheter for 2 min and measured VT and Paw.ResultsIn high-flow ventilation, the average VTs were approximately 150 ml and <100 ml with 14G catheters in complete and incomplete upper airway obstruction, respectively. The VTs obtained were reduced when the bore size was decreased. In manual ventilation, the average VTs were over 300 ml and approximately 260 ml with 14G catheters in complete and incomplete upper airway obstruction, respectively. In high-flow ventilation, the airway pressure tended to be higher. The minitracheotomy catheters produced over 800 ml of VT and created almost no positive end-expiratory pressure.ConclusionsHigh-flow ventilation tends to result in higher airway pressure despite a smaller VT, which is probably due to a PEEP effect caused by high flow.